How Prepared is the United States for a Public Health Emergency?

The Robert Wood Johnson Foundation (RWJF) released the results of the 2017 National Health Security Preparedness Index, which assessed the United States’ day-to-day preparedness in the event of a community health emergency. Although the United States improved overall in its national preparedness, the index also shows disparities in levels of preparedness between states.¹

The Preparedness Index assesses emergency preparedness based on more than 130 measures, including hazard planning in public schools, monitoring food and water safety, wireless 9-1-1 capabilities, flu vaccination rates, and numbers of paramedics and hospitals. Based on its analysis, a composite score on a 10-point scale is given.

The results for the national preparedness level showed a 16% growth in community planning and engagement and an overall 3.6% average improvement across all domains since 2013. According to the report, national health security increased consistently during this time, but at a relatively slow rate. Based on this trend, the Index concludes that it could take the United States 20 years to achieve a strong health security level of least 9.0.

The Index rated US preparedness across 6 domains: health security surveillance (7.9), community planning and engagement (5.8), incident and information management (8.2), health care delivery (5.3), countermeasure management (7), and environmental and occupational health (7).

Although the nation showed a steady improvement in its score, emergency preparedness at state levels varied. According to the Index, 20 states fell below the national average for health security and preparedness. Thirteen states met the national average and 18 states exceeded the average.

Significant disparities in preparedness scores were exhibited in several different regions, demonstrating a gap of 32% between the highest state (Vermont, 7.8) and the lowest state (Alaska, 5.9). The report noted that geographic inequities in health security are large, especially in states in the South and Mountain West compared to the Northeast and Pacific Coast states.

The report listed the rising threats to health security in the United States as:

• Newly emerging and resurgent infectious diseases like Zika, MERS, and Ebola
• Growing antibiotic resistance among infectious agents
• Incomplete vaccination coverage
• Globalization in travel and trade patterns
• Political instability, violence, and terrorism risks
• Aging infrastructure for transportation, housing, food, water, and energy systems
• Extreme weather events including storms, fires, floods, droughts and temperature extremes
• Cybersecurity vulnerabilities

“Improving health security and preparedness is important for all communities across the country. In our highly mobile country, national emergency preparedness depends on having high levels of protection in every state, city, and region,” Alonzo Plough, PhD, MPH, chief science officer and vice president at RWJF, said in a press release about the Index.² “These data highlight where strengths and gaps in preparedness lie, and can inform approaches to improve health security throughout America.”

References

• Robert Wood Johnson Foundation. The National Health Security Preparedness Index. http://nhspi.org/wp-content/uploads/2017/04/2017-NHSPI-Key-Findings.pdf. Accessed April 24, 2017.
• Deep inequities exist in states’ preparedness for public health emergencies, 2017 index shows [news release]. NHSPI’s website. http://nhspi.org/deep-inequities-exist-in-states-preparedness-for-public-health-emergencies-2017-index-shows/. Accessed April 24, 2017.